Paddock Stile Manor

We found the following examples of good practice.

¿ Checks were carried out on visitors to prevent the spread of COVID-19.

¿ Staff wore personal protective equipment (PPE) and management staff checked they did this in the right way. Staff had training in infection prevention and control measures and how to use PPE.

¿ Social distancing was encouraged, and changes had been made to support people distance from others. The registered manager understood zoning and cohorting to avoid people mixing with each other as far as possible. Staff wishing to take their breaks outside were provided with socially distant facilities.

¿ Regular testing in line with government guidelines for COVID-19 took place for people and the staff team.

¿ The home looked clean and housekeeping staff made sure they frequently cleaned touch points, such as door handles and light switches. Audits were carried out by the registered manager to check if the home was clean.

¿ Staff were supported by a range of community-based healthcare professionals to maintain people's health and well-being.

Paddock Stile Manor is a residential care home and was providing personal care to 40 people. At the time of the inspection 28 people were living at the service.

People’s experience of using this service and what we found

The service had made improvements since the last inspection and ensured only staff with the correct level of Disclosure and Barring Service (DBS) check and appropriate training were allowed to support people at mealtimes.

People and relatives told us they were happy with the care and support received.

The provider had systems in place to make sure people lived in a safe environment. Staff had a good understanding of how to keep people safe from abuse. Safeguarding concerns and incident and accidents were checked for patterns and trends.

Staff were recruited safely and received regular training and supervisions. Health and safety checks were regularly carried out and plans were in place to support people in the event of an emergency.

Recording of medicines was not always accurate which meant it was difficult to see if people had received their medicines as prescribed.

Environmental risks were identified and mitigated. Whilst the majority of risks to people had been identified we found one serious risk to a person had not been recognised and no risk assessment or guidance had been put in place to keep the person safe. The registered manager addressed this matter immediately.

The service worked in partnership with healthcare professionals and were quick to respond to changes in people’s health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Mealtime experience varied on the two days we visited, on the first day staff were not as responsive to people’s support needs whilst on the second day staff were compassionate and attentive. The registered manager told us they would look into this matter.

Staff respected people's privacy and promoted their independence. People and their relatives were involved in discussions about their care and support.

Care plans were person-centred and clearly outlined people's support and care needs. Relatives were made welcome at the service and were encouraged to take an active part in activities.

People were supported to maintain links to their local community and to take part in various activities. The provider had a complaints procedure in place and people were aware of how to make a complaint.

Feedback was regularly gathered from people, relatives and staff. The provider had a range of quality systems in place to monitor the service and drive improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (Published 2 July 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show how and by when they would improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Paddock Stile Manor is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Paddock Stile Manor provides residential care and support for up to 40 people, some of whom are living with dementia. At the time of our inspection 14 people were living at the home.

The manager was registered at another service and had started their application to add Paddock Stile Manor to their registration. They were supported by an interim manager and deputy manager.

A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected Paddock Stile Manor on 15 and 18 September 2017 and found the provider had breached five of the regulations we inspected against. The principles of the Mental Capacity Act 2005 (MCA) had not been followed and Deprivation of Liberty Safeguards (DoLS) were not appropriately monitored. Care and treatment was not being provided in a safe way, service users were not treated with dignity and respect, systems and processes had not been established or operated to effectively ensure compliance. The provider had failed to maintain securely accurate, complete and contemporaneous records in respect of each service user. Sufficient numbers of suitably competent, skilled and experienced staff had not been deployed. There was a failure to ensure staff received the appropriate induction, support, training, supervision and appraisal to enable them to carry out their duties.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Whilst the home had made some improvements we still found areas that required further advances.

The home had introduced effective systems to monitor people’s DoLS ensuring people were not being deprived of their liberty without the appropriate authorisation. We found that best interest decisions were still not decision specific. We recommended the provider consulted the Mental Capacity Act 2005 (MCA) Code of Practice.

Care plans had improved since the last inspection although the care records we viewed were not fully completed and the home did not always address identified risks.

We observed one unsafe moving and handling action. Most of our observations between staff and people were extremely positive but we did hear a lack of patience whilst staff were supporting a person in their room. Sufficient staff were deployed to ensure people’s needs were met in a timely manner.

Staff had completed mandatory training. Whilst most staff had received supervisions we found gaps in the frequency. The provider did not ensure people were supported safely during mealtimes as not all staff members supporting people to eat had the appropriate training and did not have the required DBS check.

At the last inspection we had made a recommendation about the provision of meaningful activities for people living with a dementia. The home had utilised the services of a company which specialised in virtual reality (VR) technology to explore reminiscence, they had commenced recruitment of an additional activities coordinator and sourced an external organisation which organised outings designed around people’s wellbeing.

Medicines records we viewed were accurate and up to date. People received their medicines in their preferred way. Personal emergency evacuation plans reflected people’s current needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to make day to day decisions.

The provider had introduced electronic systems to support staff in their role. Extensive quality assurance systems had been established including quality monitoring visits. Quality assurance systems were not completely effective as we identified a number of issues which the processes failed to recognise. For example, missing information in care records and lack of appropriate DBS checks.

Systems and processes were in place to safeguard people from abuse. People were provided with information on how to make a complaint. Staff told us the management team were approachable.

The home had developed good working relationships with external health care professionals visiting the service.

We found the provider had failed to implement effective governance systems in relation to premises and equipment safety and care documentation. We also made a recommendation about the recording of mental capacity assessments and best interest decisions.

Following the inspection the provider had submitted an action plan, offering assurances that the required improvements would be made by 28 April 2017. During this inspection we found evidence of continued and new breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Paddock Stile Manor is a care home with nursing for up to 40 people. It is a purpose built care home spread over two floors.

At the time of the inspection there were 30 people living at the home, some of whom were living with a dementia. 13 people resided upstairs and had been assessed as needing nursing care and 17 people lived downstairs.

The service did not have a registered manager. The current manager had been in post since March 2017. In August 2017, they had submitted an application to the Commission to be registered. The previously registered manager had left their post on 13 February 2017.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there were ongoing concerns in relation to the assessment and mitigation of risk. This included the accuracy and completeness of personal emergency evacuation plans. A failure to assess risks in relation to epilepsy, contradictions in relation to mobility and falls assessments and failure to assess environmental concerns.

Care documentation did not provide staff with sufficient information and detailed strategies to support people safely.

People’s medicines were not managed safely. Two people had not received their medicines as prescribed. There were gaps in the recording of medicines and appropriate guidance was not always in place.

Everyone we spoke with raised concerns about staffing levels. A dependency tool was used to assess people’s needs but we could not be sure this was accurate. The manager also raised concerns that the dependency tool was corrupted.

There was a reliance on agency staff, particularly nurses. This meant, given the failure to ensure accurate, up to date and complete records people were at risk of receiving care which was neither safe nor appropriate.

The concerns noted in relation to DoLS applications and authorisations meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Staff had not received appropriate induction, supervision and appraisal which meant they had not received the appropriate support to enable them to fulfil their role and meet people’s needs.

We observed people were not treated with dignity and respect. We saw one staff member ignore someone who was showing signs of distress. Some staff referred to people by their room number rather than their name. Relatives raised concerns that people’s personal appearance was being neglected. We also observed poor moving and handling practice.

We have made a recommendation about the provision of meaningful activities for people living with a dementia.

Quality assurance and good governance had not been established, audits had not been completed in a timely manner and they were not effective in identifying concerns and areas for improvement.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This was the first inspection of Paddock Stile Manor with the provider Indigo Care Services Limited.

Paddock Stile Manor is a care home with nursing for up to 40 people. It is a purpose built care home spread over two floors. The top floor of the home had been refurbished since being managed by Indigo Care Services Limited.

At the time of the inspection there were 28 people living at the home, some of whom were living with a dementia. 12 people resided upstairs and had been assessed as needing nursing care and 16 people lived downstairs.

A registered manager was registered with the Care Quality Commission at the time of the inspection.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found the provider had breached the regulations relating to safe care and treatment and good governance. The risk assessment process had failed to ensure all risks had been identified and assessed. For example, for people living with epilepsy and for one person in relation to a choking risk. There were discrepancies in relation to the frequency of overnight checks and positional changes which meant people may not have been receiving appropriate care and support. Nurse call bells in communal areas had been tied up out of people’s reach so they would be unable to use them if they needed to call for help or support. Fire exits had been used to store items such as staff coat’s, bed rail bumpers, water bottles, foots stools and ladders.

The quality assurance processes for ensuring care plans and risk assessments were complete and accurate were not effective as they had not identified the concerns noted during the inspection.

We found the provider had failed to implement effective governance systems in relation to premises and equipment safety.

We have made a recommendation about the recording of mental capacity assessments and best interest decisions.

You can see what action we told the provider to take at the back of the full version of the report.

Recruitment processes included appropriate checks before staff commenced in post however there was no record of one staff member’s references on file and not all agency staff had documented checks in place prior to them working at the home.

Staff had attended regular training and they told us they felt supported by the registered manager and nursing staff. We found some gaps in the delivery of supervisions and appraisals but this was being addressed. Staff understood how to report accidents, incidents and safeguarding concerns.

People and visitors told us staff treated them with dignity and respect. We saw compassionate and caring interactions between staff and people. For example, offering reassurance when supporting people with mobility needs.

People were appropriately supported with their medicines, nutritional needs and had access to healthcare professionals when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

There were two activities co-ordinators in post. Activities ranged from events in the community, such as coffee mornings and outings, to exercise, dance, musical instruments and arts and crafts. A men’s group was available and the activities co-ordinator explained how they tried to ensure some activities related to people’s interests, hobbies or past employment.

A complaints procedure was in place and there had been no complaints since the last inspection.